<include file="Public:header" />

<include file="Public:left_menu" />  

<div id="content">
<h2>Fraud Report</h2>
<p>这个需要特殊授权：即每个公司的主要负责人或者他授权给他人填写。						</p>
<p>在打开填写页面之前，要有一个免责声明，即系统软件服务公司不承担任何责任和后果，填写人即其公司承担相应的责任和后果，客人选择同意后，才能进行填写内容。</p>
<p>在客人没有缴纳特殊服务费前，只能查询到自己填写的black list 信息。根据所有填写的内容查询。如果客人缴费后，即可查询到系统后台数据库里的信息</p>


<h4 class="box_title">New Fraud Report</h4>

<form action="#" method="post">
				 <table width="100%" cellspacing="0" cellpadding="0" border="0" class="tables v2">
     				<tbody>
            <tr>
                <th width="200"> Company Name:</th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
              <tr>
                <th> First Name: </th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
              <tr>
                <th> Last Name	:</th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
             
              <tr>
                <th> 	Living Address: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	Licent Numner: </th>
                <td>  
                			<select>
                						<option>Driver Licence Number </option>	
                      <option>Passort Number</option>	
                      <option>Citizen Number </option>	
                      <option>Other</option>	
                 
 
                			</select>
                 </td>
             </tr> 
               <tr>
                <th> 	</th>
                <td>  
                <input type="text" name="email" /> 
                 </td>
             </tr> 
              <tr>
                <th> 	 	Mailing Address: </th>
                <td>   <input type="text" name="title" /> </td>
             </tr> 
             
              <tr>
                <th> 	Company Address: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
              <tr>
                <th> 	Company Mailing Address: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	Company Register Number: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	City: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
             
              <tr>
                <th> 	State: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
             
              <tr>
                <th> 	 Country: </th>
                <td>    <textarea name="content"></textarea>  </td>
             </tr>
             
              <tr>
                <th> 	Postal Code: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr>  
             
            
 
             
             <tr>
                <th> 	  Varify: </th>
                <td>    		<input type="text" name="verify" /> </td>
             </tr> 
             
             <tr>
                <th> 	  </th>
                <td>    <img src="{$SITE_URL}/biz.php?s=Public/verify" /><img src="/Index/verify/" /></td>
             </tr>
             
              <tr>
                <th> 	  </th>
                <td>     <input type="submit" name="submit" value="Submit" /></td>
             </tr>
             
              

        
        
        
        
        
        </table>
        
	</form>




<h4 class="box_title">Get Fraud Report</h4>

<form action="#" method="post">
				 <table width="100%" cellspacing="0" cellpadding="0" border="0" class="tables v2">
     				<tbody>
            <tr>
                <th width="200"> Company Name:</th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
              <tr>
                <th> Company Address: </th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
              <tr>
                <th> Company Register Number	:</th>
                <td>   <input type="text" name="name" /> </td>
             </tr>
             
              <tr>
                <th> 	City: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	State: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
              <tr>
                <th> 	 	Country: </th>
                <td>   <input type="text" name="title" /> </td>
             </tr> 
             
              <tr>
                <th> 	Post Code: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
              <tr>
                <th> 	First Name: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	Last Name: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
              <tr>
                <th> 	Tel Number: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
             
              <tr>
                <th> 	Fax Number: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
             
              <tr>
                <th> 	 Living Address: </th>
                <td>    <input type="text" name="email" />   </td>
             </tr>
             
              <tr>
                <th> 	Call Number: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr>  
             
              <tr>
                <th> 	ID Number: </th>
                <td>   <input type="text" name="email" /> </td>
             </tr> 
             
             
     
             
             <tr>
                <th> 	  Varify: </th>
                <td>    		<input type="text" name="verify" /> </td>
             </tr> 
             
             <tr>
                <th> 	  </th>
                <td>    <img src="{$SITE_URL}/biz.php?s=Public/verify" /><img src="/Index/verify/" /></td>
             </tr>
             
              <tr>
                <th> 	  </th>
                <td>     <input type="submit" name="submit" value="Submit" /></td>
             </tr>
             
              

        
        
        
        
        
        </table>
        
	</form>
</div>

<include file="Public:footer" />